Foot venous pressure measurement for evaluation of lower limb venous insufficiency

Abstract

Purpose: Foot venous pressure measurement is considered to be useful for assessing lower limb venous insufficiency, because venous hypertension is the main factor predisposing to venous insufficiency. In this study, we investigated the utility of foot venous pressure measurement in the evaluation of venous insufficiency. Methods: A total of 148 limbs of 101 patients with venous insufficiency associated with varicose veins and treated over 5 years were studied. The measurements assessed were percentage decrease in foot venous pressure with manual calf compression (%drop), rate of increase in foot venous pressure during a 4-second period after release of compression (4SR%), and time to 50% recovery of foot venous pressure (RT50). Results: A higher incidence of skin changes (clinical, etiologic, anatomic, and pathophysiologic classification classes 4 to 6) caused by venous insufficiency was associated with %drop, 4SR%, and RT50 values. Skin changes were found in more than 50% of the limbs with a %drop less than 50%, 4SR% more than 50%, or RT50 less than 4 seconds. After tourniquets were applied to occlude the superficial veins, limbs with severe below-knee deep venous reflux (%drop 60.3 ± 14.6, 4SR% 36.7 ± 30.2, RT50 13.9 ± 14.7) showed significantly worse values than those with no reflux (%drop 79.9 ± 3.2, 4SR% 8.1 ± 3.1, RT50 48.9 ± 17.9) or with mild above-knee reflux (%drop 77.0 ± 5.0, 4SR% 7.1 ± 3.2, RT50 46.9 ± 26.7). After sclerotherapy or surgical treatment, including deep venous reconstruction for severe below-knee reflux, all limbs showed significant improvement in clinical manifestations and foot venous pressure values (%drop 68.1 ± 7.5 to 76.5 ± 5.8, 4SR% 33.1 ± 12.9 to 12.7 ± 7.6, RT50 7.5 ± 4.2 to 20.1 ± 6.5). Conclusion: Foot venous pressure measurements showed a good correlation with clinical severity and degree of venous reflux and were very useful for evaluating the outcome of therapy for venous insufficiency. (J Vasc Surg 1998;27:671-76.)